A Guide to Headaches

Thousands of men, in their relationships, have often received the following reply from their partner when asking for a bit of affectionate sex: ‘Darling, not now, I’ve got a headache’. A highly pertinent response and one that is difficult to refute, since, put like that, a headache is invisible. So, at times, as a means of avoidance, a headache serves as a safe haven to ward off bouts of desire deemed inappropriate. To be fair, in Italy – and to some extent worldwide – headaches are a gender-specific condition, as women are more frequently affected, at a ratio of 3 to 1 compared to men, generally in the 15 to 50 age group. In Italy, around 10–12 million people suffer from them, accounting for approximately 12 per cent of the general population.

So much for the statistics. This condition, which can at times become truly debilitating, has been a constant feature of human history, if one considers trepanation – the drilling of the skull – as a practice once believed to be curative for the treatment of migraines, epileptic seizures or other mental disorders, as evidenced by artefacts dating back as far as the 5th millennium BC, discovered in the Americas, in Europe, in China, in Magyar cemeteries and in Siberia. And if we consider the various accounts left in their writings by figures such as Julius Caesar, Charles Darwin, Friedrich Nietzsche, Sigmund Freud, Miguel de Cervantes, Lewis Carroll, Thomas Jefferson, Giulio Andreotti and countless others who suffered from it extensively. We can therefore state that headaches are ubiquitous. Proof of this is that it is present, to a statistically significant extent, in Europe, where Belgium ranks highest, followed by Spain, France and Italy, whilst in South America Brazil tops the list, although it is also present in several countries in North Africa and the Middle East.

But beyond the various classifications and different labels, one thing is certain: it exists and is a condition from which no one can claim to be immune, as everyone has experienced it at least once in their life. If this is true, however, we must ask ourselves why it occurs and what might cause it, bearing in mind that, regardless of the colloquial term used to describe it, in more scientific terms it falls under the general term ‘headache’ or, more specifically, ‘migraine’. It is generally a fairly complex neurological disorder, which may be linked to various factors such as a genetic predisposition – also known as hereditary diathesis – or even a temporary disturbance of the central nervous system and the blood vessels supplying it. However, headache and migraine are not synonymous. In practice, ‘headache’ is the term used to describe any type of head pain, whilst a migraine is a distinct neurological condition. The most common type of headache is the tension-type headache, caused by stress, physical fatigue and muscle tension, and is characterised by a sensation of a tight band around the head or constant pressure. Cluster headaches, on the other hand, are much more painful and present as acute attacks that may recur even within a short period of time. The causes of this type of headache can include hormonal fluctuations – particularly in women during their menstrual cycle – lack of sleep, fever, sinusitis, specific foods and head injuries. A migraine is characterised by its duration, which can range from four to seventy-two hours; it is often localised to one side of the head, can be throbbing, and is frequently accompanied by nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia) and visual disturbances. Sometimes it may be preceded by a warning sign known as an aura. The ways in which these symptoms may occur are generally also attributable to other triggers, such as the activation and irritation of the fifth cranial nerve – known as the ‘trigeminal’ nerve – which is, in a sense, the ‘prince’ of the head’s nerves, comprising an ophthalmic branch, a maxillary branch and a mandibular branch. Irritation of this nerve can be caused by speaking, draughts, chewing or even brushing one’s teeth. In practice, when this nerve becomes irritated, it releases a protein called CGRP (calcitonin gene-related peptide) around the blood vessels and the meninges. This protein, together with other associated elements, causes the small cerebral arteries to dilate, triggering signals of very intense pain and setting in motion the cascade of symptoms associated with these troublesome headaches.

However, other factors that can trigger the condition include muscle tension in the neck, shoulders and jaw, which may also be caused by poor posture or stress. The period leading up to the menopause. Windy days. Lifestyle factors such as jet lag, insomnia, dehydration, prolonged fasting and excessive caffeine consumption. Or even environmental factors such as poorly ventilated rooms, intense artificial lighting and loud noises. In addition to these factors, high blood pressure – which can manifest as a morning headache – vision problems and poor dental occlusion may also play a part.

It was said, however, that certain foods may also play a role in the onset of headaches due to the presence of substances which, as has now been established, make it easier for these troublesome symptoms to be triggered. These substances include nitrates and nitrites, used as preservatives in sausages, hams, salami and mortadella; tyramine, found in abundance in mature cheeses such as Gorgonzola, Cheddar, Grana and Pecorino; and monosodium glutamate, used in pre-packaged foods and stock cubes. Not only these, but other substances present in wine – such as sulphates and sulphites, used as stabilisers and preservatives – are responsible for triggering these symptoms, not to mention that the most ‘harmful’ in terms of triggering headaches is undoubtedly white wine, as it requires a much more sophisticated stabilisation process than red wine, such as its clarification, for which substances derived from chicken eggs (egg wash), casein (a milk protein) and another chemical such as bentonite are used. It is clear that, in individuals sensitive to these substances, the likelihood of triggering general problems such as intolerances and associated headaches can become much higher. The remedies for dealing with headaches and migraines are painkillers. In Italy, the excessive use of painkillers for headaches is a significant problem that can lead to so-called medication-overuse headache, a chronic condition affecting around 1–2 per cent of the general population. Paradoxically, the risk associated with this overuse is the rebound effect, as taking analgesics with a certain frequency can trigger a vicious circle in which the medication itself contributes to the pain becoming chronic. In fact, according to certain scientifically endorsed guidelines, the use of substances such as paracetamol, triptans and opioids more than twice a week can significantly increase the likelihood of worsening symptoms.

But as it is, as mentioned, a condition that affects a great many people, it is only natural to find references to this issue in literature. Indeed, many authors have attempted to describe headaches through their writing, although it is by no means an easy subject to convey. It has also been described as an ‘invisible ailment’ and an ‘intimate pain’. Oliver Sacks, the renowned British neurologist and writer, devoted an entire book to the subject in 1970, entitled Migraine. In addition to a rigorously scientific description of the phenomenon, he reflects – including through a pertinent philosophical meditation – on the unity between mind and body, describing migraine as a unique and unshareable experience for each individual. Virginia Woolf, in her famous essay on the condition (On Being III, 1926), reflects on how literature has neglected the ailing body in favour of the activities of the mind. The author herself lived with frequent bouts of headache throughout her life, highlighting the inadequacy of everyday language when it comes to describing physical suffering. Meanwhile, on the other side of the world, the Salvadoran writer Roque Dalton Garcia penned the well-known poem Sobre dolores de cabeza, in which he describes the condition as a historical and political burden borne by communist revolutionaries, one that does not even subside with the use of common painkillers. Conversely, during the Middle Ages, Jacopone da Todi, in his famous lauda O Signor, per cortesia (O Lord, out of kindness), even invokes illness and physical torment – explicitly mentioning ‘headache’ and acute pains – as a sign of humility and spiritual purification before God.

In her collection Cefalea cronica, the poet Valentina Belgrado uses verse to give voice to that ‘sharpshooter’ that is chronic pain, capable of isolating those who suffer from it, altering their perception of time, sound and light, and making it impossible to communicate their suffering to others. Or, to take another example, the great Fernando Pessoa wrote, ‘I have a headache because I have a headache. The universe hurts because my head hurts’”, and so on. However, there is also the metaphor of the headache, and there are countless examples in everyday life. Phrases such as “I listened to someone who gave a lecture and read from some papers for three-quarters of an hour – what a headache…” or “I spent two hours stuck in a traffic jam on the motorway – what a headache…”, “the beach was full of rowdy louts blasting music and whingeing children – what a headache”, “there was an insane din in that restaurant – what a headache”, “my flight to Catania was delayed by two hours – what a headache”, “I attended the presentation of the budget to the town council – a headache”, “that bloke who parks his car next to mine is a jinx, in my opinion; he gives me a headache”, “turn that music down! It’s giving me a headache”. But, whatever the circumstances, a headache is always a strictly personal experience. Just like a friendly acquaintance of mine, a notorious drinker, told me some time ago one morning at the café, over a caffè ristretto, after a heroic night out: “This morning I feel like I’ve got a tracked tractor inside my head. No! Actually, let me put it more precisely. A herd of charging bison, where every now and then one – just one – kicks me, making my whole body shake.”